New Mexico Self-Insured Group Tax Quarterly Return

Self-Insured Group Tax Quarterly Return
Form TRD-41398
New Mexico Taxation and Revenue Department

TRD-41398
Rev. 07/01/2023

Self-Insured Group Tax and Self-Procured Premium Tax
Quarterly Return
NAIC NUMBER:

STREET/BOX:

FEIN, SSN, or ITIN:

CITY, STATE, ZIP

E-MAIL

CONTACT NAME:

PHONE:

WHO MUST FILE: The Self-Insured Group Tax pursuant to Section 7-40-3(G) NMSA 1978 is due by any company that has premiums derived from
standard premium adjusted by any advance premium discount as defined in the Group-Self Insurance Act (Chapter 52 Article 6). For more information
on a self-insured group see the instructions on the next page. The Self-Insured Group Tax pursuant to Section 7-40-7(C) NMSA 1978 must be paid on a
quarterly basis. The Self-Insured Group Tax estimated payments and returns are due on April 15, July 15, October 15, and January 15. Estimated payments shall be at least one-fourth or 25% of the payment made during the previous calendar year. The final adjustment for payments due for the prior
year shall be made with the annual return filed on April 15th.
The Self-Procured Premium Tax pursuant to Section 7-40-3(A) NMSA 1978 is due by a taxpayer that is an insured that procures, continues or renews
insurance with a nonadmitted insurer, paid by the taxpayer, on insurance or contracts covering risks within the state during the preceding calendar
year. The Self-Procured Premium Tax pursuant to Section 7-40-7(A) NMSA 1978 must be paid on a quarterly basis. The Self-Procured Premium Tax
estimated payments and returns are due on April 15, July 15, October 15, and January 15. Estimated payments shall be at least one-fourth, 25% of the
payment made during the previous calendar year or one-fifth, 20% of the actual payment due for the current calendar year, whichever is greater. The
final adjustment for payments due for the prior year shall be made with the annual return filed on April 15th.

Tax Period:

through
Month

Check if amended

Day

Year

Month

Day

Year

Reason for amending:

E-FILE: You must e-file and e-pay Insurance Self Insured (ISI), which includes Self-Insured Group Tax and Self-Procured Premium Tax, using the
Department’s Taxpayer Access Point (TAP) website at https://tap.state.nm.us. This program has an electronic file (e-file) mandate. If for some reason
you are unable to file the return electronically through TAP you are able to request a waiver or exception for e-filing using the Forms RPD-41351, E-File
Waiver Request Form and RPD-41350, E-File Exception Request Form.
Self-Insured Group Tax
1.	

Prior Year Self-Insured Group Tax Liability (as reported on prior year's annual tax filing)..........................................................................................

2.	

Enter No Less than 25%......................................................................................................................................................................

3.	

Quarterly Payment Due (multiply line 1 by line 2)....................................................................................................................................

Self-Procured Premium Tax

x
=

1.
2.
3.

4.	

Prior Year Self-Procured Premium Tax Liability (as reported on prior year's annual tax filing)..................................................................................

4.

5.	

25% of Total Prior Year Tax Liability (multiply line 4 by 25%)..............................................................................................................

5.

6.	

20% of Actual Payment due for the Current Calendar Year................................................................................................................

6.

7.	

Quarterly Payment Due (enter greater amount from line 5 and line 6)...............................................................................................

7.

Total Tax Due
8.	

Tax Due (add lines 3 and 7).................................................................................................................................................................

9.	

Penalty.................................................................................................................................................................................................

10.	 Interest.................................................................................................................................................................................................
11.	 Total Amount Due................................................................................................................................................................................

+
+
=

8.
9.
10.
11.

Taxpayer's Signature
I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.

Authorized Signature

Date

Title

Phone Number

%

***This program has an electronic filing mandate. An e-file exception or waiver can be requested to submit a paper return.***

NAME OF INSURER:

TRD-41398
Rev. 07/01/2023

New Mexico Taxation And Revenue Department

Self-Insured Group Tax and Self-Procured Premium Tax

Quarterly Return Instructions

Pursuant to Section 7-40-2 NMSA 1978, each unauthorized insurer that has assumed a contract or policy of insurance directly
or indirectly from an authorized or formerly authorized insurer and
is receiving premiums on such policies remaining in force in New
Mexico; provided that the ceding insurer does not continue to pay
the taxes imposed pursuant to the Insurance Premium Tax Act as
to such policy or contract are subject to the Self-Insured Group
Tax.

for payments due for the prior year shall be made with the annual
return filed on April 15th.

Quarterly Filing
Period Begins Period Ends
Due Date
1 January 1st
st
March 31
April 15th
2 April 1st
June 30th
July 15th
3 July 1st
September 30th October 15th
4 October 1st
December 31st January 15th

The Self-Procured Group Tax pursuant to Section 7-40-3(A) NMSA
1978 is due by each insured who in this state procures or continues or renews insurance with a nonadmitted insurer on a risk
located or to be performed in whole or in part in this state, other
than insurance procured through a surplus lines as defined in the
Group-Self Insurance Act (Chapter 59 Article 15).

PAYMENTS
Estimated payments for the Self-Insured Group Tax shall be at
least one-fourth or 25% of the payment made during the previous calendar year. The final adjustment for payments due for the
prior year shall be made with the annual return filed on April 15th.
Estimated payments for the Self-Procured Premium Tax shall be
at least one-fourth, 25% of the payment made during the previous calendar year or one-fifth, 20% of the actual payment due for
the current calendar year, whichever is greater. The final adjustment for payments due for the prior year shall be made with the
annual return filed on April 15th. Refer to FYI 401, Special Payment Methods for more information. Make the check or money
order payable to New Mexico Taxation and Revenue Department.
Mail the payment and all required documentation to Taxation and
Revenue Department, P.O. Box 5557, Santa Fe, NM 87502 Email:
[email protected]. Certified or overnight mailing
address: Attn-Insurance Premium Tax, 1200 S. St. Francis Drive,
Santa Fe, New Mexico 87504.

This program, which includes Self-Insured Group Tax and SelfProcured Premium Tax, has an electronic file (e-file) mandate. If for
some reason you are unable to file the return electronically through
TAP you are able to request a waiver or exception for e-filing using
the Forms RPD-41351, E-File Waiver Request Form and RPD41350, E-File Exception Request Form.

NOTE: When you provide a check as payment, you authorize us
to use information from your check to make a onetime electronic
fund transfer from your account. When we use information from
your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day you make your
payment.

For a self-insured group, "group" per Section 52-6-2(B) NMSA
1978 means a not-for-profit unincorporated association consisting
of two or more public hospital employers or private employers that
are engaged in the same or similar type of business, are members
of the same bona fide trade or professional association that has
been in existence for not less than five years and that enter into
agreements to pool their liabilities for workers' compensation benefits; except that public hospital employers shall segregate their
accounting records and investment accounts from those of private
employers in accordance with applicable state law

COMPLETED RETURNS
All fields in the form must be completed. No field should be left
blank. For numeric fields requiring a balance, mark the field as
zero if there no activity or balance related to that field. For forms
to be considered complete, they must be signed, with the Title and
Date entered by Authorized Representative.
QUARTERLY TAX RETURNS
The Self-Insured Group Tax pursuant to Section 7-40-7(C) NMSA
1978 must be paid on a quarterly basis. The Self-Insured Group
Tax estimated payments and returns are due on April 15, July 15,
October 15, and January 15. Estimated payments shall be at least
one-fourth or 25% of the payment made during the previous calendar year. The final adjustment for payments due for the prior year
shall be made with the annual return filed on April 15th.
The Self-Procured Premium Tax pursuant to Section 7-40-7(A)
NMSA 1978 must be paid on a quarterly basis. The Self-Procured
Premium Tax estimated payments and returns are due on April 15,
July 15, October 15, and January 15. Estimated payments shall be
at least one-fourth, 25% of the payment made during the previous
calendar year or one-fifth, 20% of the actual payment due for the
current calendar year, whichever is greater. The final adjustment

LINE INSTRUCTIONS
Line 1. Prior Year Self-Insured Group Tax Liability. This is the
number reported on your prior year's annual tax filing.
Line 2. Enter No Less Than 25%. Enter a number that is 25 or
higher. This number should be at least one-fourth or 25% per Section 7-40-7(C) NMSA 1978.
Line 3. Quarterly Payment Due. Multiply the amount in line 1 by
line 2.
Line 4. Prior Year Self-Procured Premium Tax Liability. This is
the number reported on your prior year's annual tax filing.
Line 5. 25% of Total Prior Year Tax Liability. Multiply Line 4 by
25%.
Line 6. 20% of Actual Payment due for the Current Calendar
Year. This amount must be equal to 20% of the actual payment
due for the calendar year. Note: This amount is not calculated
using the quarterly tax due. This amount must be 20% of the projected annual tax due

***This program has an electronic filing mandate. An e-file exception or waiver can be requested to submit a paper return.***

WHO MUST FILE
The Self-Insured Group Tax pursuant to Section 7-40-3(G) NMSA
1978 is due by any company that has premiums derived from standard premium adjusted by any advance premium discount as defined in the Group-Self Insurance Act (Chapter 52 Article 6).

TRD-41398
Rev. 07/01/2023

New Mexico Taxation And Revenue Department

Self-Insured Group Tax and Self-Procured Premium Tax

Quarterly Return Instructions

Line 8. Tax due. Enter the total of Lines 3 and 7.
Line 9. Penalty. Add penalty if the entity fails to file timely or to pay
the amount on Line 3 when due. Calculate the penalty by multiplying the amount on Line 8 by 2%, then by the number of months
or partial months for which the return or payment is late, not to
exceed 20% of the tax due. Penalty for failure to file or pay on time
may not be less than $5.00.
Line 10. Interest. Interest accrues daily on the unpaid principal of
tax due, and it can change on a quarterly basis.
Interest is calculated daily but the rate will be set at the rate established for individual income tax purposes by the U.S. Internal
Revenue Code (IRC). The IRC rate, which changes quarterly, is
announced by the IRS in the last month of the previous quarter.
The annual and daily interest rates for each quarter are posted
on our website at https://www.tax.newmexico.gov/individuals/fileyour-taxes-overview/penalty-interest-rates/.
Tax Due X Daily Interest Rate for the Quarter X Number of Days
Late = Interest Due.
Line 11. Total Amount due. Enter the total of Lines 8, 9 and 10.
Pay this amount.
Taxpayer's Signature. This return needs to be signed by the authorized and include the date and title of that individual along with
a phone number where they can be reached.

***This program has an electronic filing mandate. An e-file exception or waiver can be requested to submit a paper return.***

Line 7. Quarterly Payment Due. Enter the greater amount from
line 5 and line 6